Dual ligating and dividing apparatus

Abstract

The invention provides an apparatus and method for tissue ligation and transection. In a preferred embodiment, the apparatus comprises a shaft with a slot at the distal end in which a tissue structure may be positioned. A suture is mounted about the periphery of the slot with a free end of the suture on a first side of the slot and a knotted loop on a second side of the slot. The free end of the suture is retrieved and threaded through knotted loop so as to form a ligature surrounding the tissue structure. The free end is drawn proximally to tighten the ligature, and the knotted loops are cinched tight to lock the ligature in position. A blade slidably mounted in the shaft may be advanced to transect the tissue structure adjacent or between ligatures. A sleeve for compressing tissue within the slot during ligation, as well as electrodes for cauterizing the tissue, are also disclosed.

What is claimed is: 
     
       1. Ligating apparatus comprising: a shaft having a distal end, a proximal end, and a slot near the distal end in which tissue may be positioned;   a first suture detachably mounted at the distal end, the suture having a free end disposed on a first side of the slot, a knotted loop disposed on a second side of the slot opposite the free end and a cinching line extending proximally from the knotted loop;   means attached to the shaft for threading the free end through the knotted loop while tissue is positioned in the slot such that the suture forms a ligature surrounding the tissue;   means attached to the shaft for tightening the ligature by pulling the free end axially relative to the shaft; and   means attached to the shaft for cinching the knotted loop by pulling proximally on the cinching line.   
     
     
       2. The apparatus of claim 1 wherein the threading means comprises a rod slidably mounted to the shaft and extending through the knotted loop with means at a distal end thereof for retrieving the free end of the suture. 
     
     
       3. The apparatus of claim 2 wherein the suture further comprises anchor means at the free end for engaging the retrieving means. 
     
     
       4. The apparatus of claim 3 wherein the anchor means comprises a snap fixed to the free end, the retrieving means comprising a snap fitting for engaging the snap. 
     
     
       5. The apparatus of claim 3 wherein the retrieving means comprises a hook for engaging the anchor means. 
     
     
       6. The apparatus of claim 5 wherein the anchor means comprises a ball fixed to the free end. 
     
     
       7. The apparatus of claim 5 wherein the anchor means comprises a knot tied in the free end. 
     
     
       8. The apparatus of claim 2 wherein the rod is slidable proximally along the shaft with the free end attached thereto to tighten the ligature. 
     
     
       9. The apparatus of claim 1 further comprising a movable jaw pivotally coupled to the shaft near the distal end, the jaw forming one side of the slot. 
     
     
       10. The apparatus of claim 9 wherein the jaw has a proximal end coupled to the shaft and a distal end on which the free end of the suture is disposed, the knotted loop being disposed on the shaft opposite the free end, whereby closure of the jaw toward the shaft threads the free end through the knotted loop. 
     
     
       11. The apparatus of claim 10 wherein the suture further comprises anchor means attached to the free end. 
     
     
       12. The apparatus of claim 11 wherein the means for retrieving comprises a hook for engaging the anchor means. 
     
     
       13. The apparatus of claim 11 wherein the anchor means comprises a ball fixed to the free end. 
     
     
       14. The apparatus of claim 1 further comprising a second suture detachably secured to the shaft generally parallel to the first suture and spaced apart therefrom. 
     
     
       15. The apparatus of claim 14 further comprising a cutting blade slidably disposed in the shaft adjacent the first suture for dividing tissue. 
     
     
       16. The apparatus of claim 1 further comprising means at the proximal end of the shaft for sequentially actuating the threading means, tightening means and cinching means. 
     
     
       17. The apparatus of claim 1 further comprising a trimming blade mounted in the shaft for trimming off the cinchline and the free end after the ligature has been tightened. 
     
     
       18. The apparatus of claim 1 further comprising at least one electrode disposed adjacent the slot for cauterizing tissue. 
     
     
       19. The apparatus of claim 1 wherein the shaft further comprises a sleeve slidable with respect to the slot to compress tissue within the slot. 
     
     
       20. The apparatus of claim 1 wherein the shaft comprises a removable cartridge mounted at its distal end, the cartridge including the slot and the first suture. 
     
     
       21. Ligating apparatus comprising: a shaft having a distal end, a proximal end, and a slot near the distal end in which tissue may be positioned;   a first suture detachably mounted at the distal end, the suture having a free end disposed on a first side of the slot, a knotted loop disposed on a second side of the slot opposite the free end and a cinching line extending proximally from the knotted loop;   means on the shaft for threading the free end through the knotted loop while tissue is positioned in the slot such that the suture forms a ligature surrounding the tissue;   a first rod slidably mounted in the shaft for pulling the free end axially relative to the shaft to tighten the ligature; and   an actuator connected to the cinching line and slidably coupled to the shaft at the proximal end, wherein proximal translation of the actuator draws the cinchline to tighten the knot.   
     
     
       22. The apparatus of claim 21 wherein the threading means comprises a snap fitting mounted to a distal end of the rod and extending through the knotted loop, the suture further comprising a snap attached to the free end for coupling to the snap fitting, wherein the snap fitting engages the snap when the rod is moved distally and the free end is drawn through the knotted loop when the rod is moved proximally. 
     
     
       23. The apparatus of claim 21 wherein the suture further comprises anchor means attached to the free end. 
     
     
       24. The apparatus of claim 23 wherein the means for threading comprises a hook at a distal end of the rod and extending through the knotted loop, the hook engaging the anchor means when the rod is moved distally and drawing the free end through the knotted loop when the rod is moved proximally. 
     
     
       25. The apparatus of claim 24 wherein the anchor means comprises a ball fixed to the free end. 
     
     
       26. The apparatus of claim 24 wherein the anchor means comprises a knot tied in the free end. 
     
     
       27. The apparatus of claim 21 wherein the means for threading comprises a movable jaw forming one side of the slot, the jaw having a proximal end pivotally coupled to the shaft and a distal end on which the free end of the suture is disposed, the knotted loop being disposed on the shaft opposite the free end, whereby closure of the jaw toward the shaft threads the free end through the knotted loop. 
     
     
       28. The apparatus of claim 27 wherein the suture further comprises anchor means attached to the free end. 
     
     
       29. The apparatus of claim 28 wherein the rod has a hook at a distal end thereof for engaging the anchor means when the rod is moved distally. 
     
     
       30. The apparatus of claim 29 wherein the anchor means comprises a ball fixed to the free end. 
     
     
       31. The apparatus of claim 21 further comprising: a second suture detachably secured to the shaft generally parallel to the first suture and spaced apart therefrom, the second suture having a second free end on the first side of the slot, a second knotted loop on the second side of the slot and a second cinchline extending proximally from the second knotted loop and attached to the actuator;   means on the shaft for threading the second free end through the second knotted loop while tissue is positioned in the slot such that the second suture surrounds the tissue; and   a second rod slidably disposed in the shaft parallel to the first rod for pulling the second free end relative to the second knotted loop to tighten the second suture.   
     
     
       32. The apparatus of claim 31 further comprising a cutting blade slidably disposed in the shaft adjacent the first suture for dividing tissue. 
     
     
       33. The apparatus of claim 32 wherein the blade is disposed between the first and second sutures. 
     
     
       34. The apparatus of claim 32 wherein the first and second sutures are disposed on the same side of the blade. 
     
     
       35. The apparatus of claim 32 further comprising a third suture detachably mounted to the shaft generally parallel to the first suture and a fourth suture detachably mounted to the shaft generally parallel to the second suture. 
     
     
       36. The apparatus of claim 35 wherein the first and third sutures are disposed on a side of the blade opposite the second and fourth sutures. 
     
     
       37. The apparatus of claim 32 further comprising means at the proximal end for actuating the blade. 
     
     
       38. The apparatus of claim 21 wherein the slot is open in a lateral direction with the first side facing proximally and the second side facing distally. 
     
     
       39. The apparatus of claim 38 further comprising means on the shaft for compressing tissue within the slot. 
     
     
       40. The apparatus of claim 39 wherein the compressing means comprises a sleeve slidably mounted to the shaft and movable with respect to the first side of the slot, the sleeve having a distal surface for compressing tissue against the first side of the slot. 
     
     
       41. The apparatus of claim 21 further comprising means adjacent the slot for cauterizing tissue. 
     
     
       42. The apparatus of claim 41 wherein the cauterizing means comprises a first electrode on the first side of the slot and a second electrode on the second side of the slot. 
     
     
       43. The apparatus of claim 21 further comprising a trim blade mounted in the shaft for trimming off the cinchline and the free end after the ligature is tightened. 
     
     
       44. The apparatus of claim 21 wherein the shaft comprises a removable cartridge mounted at its distal end, the cartridge mounted at its distal end, the cartridge including the slot and the first suture. 
     
     
       45. The apparatus of claim 44 wherein the first rod is slidably disposed in the cartridge and has an interconnect at its proximal end for detachably coupling to a linkage in the shaft. 
     
     
       46. The apparatus of claim 44 wherein the cinchline is connected to a slidable block in the cartridge, the block having an interconnector for detachably coupling to a linkage connected to the actuator. 
     
     
       47. Dual ligating and dividing apparatus comprising: a shaft having a distal end, a proximal end, and a laterally-oriented slot near the distal end in which tissue may be positioned;   a pair of sutures detachably mounted at the distal end parallel to and spaced apart from one another, the sutures each having a free end disposed on a first proximally-facing side of the slot, a knotted loop disposed on a second distally-facing side of the slot and a cinching line extending proximally from the knotted loop;   a pair of rods slidably mounted in the shaft and extending through the knotted loops, the rods each having a distal end with means for retrieving the free ends and drawing the free ends through the knotted loops;   an actuator coupled to the shaft at the proximal end, the first and second cinchlines being connected to the actuator; and   a blade slidably mounted to the shaft between the sutures and movable with respect to the slot for dividing tissue.   
     
     
       48. The apparatus of claim 47 wherein the means for retrieving comprises a snap fitting on the distal end of each rod, the sutures further comprising a snap on the free ends for coupling to the snap fitting when the rods are moved distally. 
     
     
       49. The apparatus of claim 48 further comprising a pair of bipolar electrodes mounted adjacent the slot for cauterizing tissue. 
     
     
       50. The apparatus of claim 47 further comprising a sleeve slidably mounted on the shaft and having a distal surface for compressing tissue against the first side of the slot. 
     
     
       51. A method of ligating a body structure, said method comprising: providing a ligation apparatus having a shaft with a distal end and a proximal end, a rod which is axially translatable relative to the shaft, and an actuator which is separately axially translatable relative to the shaft;   positioning the apparatus such that a portion of the body structure is within a slot at the distal end of the shaft, with a free end of a first suture being disposed on one side of the slot and a knotted loop in the suture being disposed on an opposing side of the slot;   threading the free end through the knotted loop such that the suture forms a first ligature surrounding the structure;   retrieving the free end with the distal end of the rod;   tightening the first ligature tightly around the structure by sliding the rod in a proximal direction relative to the shaft; and   cinching the knotted loop using the actuator, the actuator being connected to a cinchline extending proximally from the knotted loop.   
     
     
       52. The method of claim 51 wherein the apparatus further includes a second suture disposed at the distal end of the shaft generally parallel to the first suture and spaced apart therefrom, the second suture having a second free end and a second knotted loop on opposing sides of the slot, the method further comprising: threading the second free end through the second knotted loop such that the second suture forms a second ligature surrounding the structure;   retrieving the second free end with the distal end of a second rod slidably disposed in the shaft;   tightening the second suture around the structure by sliding the second rod in a proximal direction; and   cinching the second knotted loop using the actuator, the second suture having a second cinchline extending from the second knotted loop to the actuator.   
     
     
       53. The method of claim 52 further comprising dividing the body structure between the first and second sutures after the steps of tightening the first and second knotted loops. 
     
     
       54. The method of claim 53 further comprising compressing the tissue in the slot. 
     
     
       55. The method of claim 54 further comprising cauterizing tissue in the slot by means of electrodes mounted adjacent the slot. 
     
     
       56. The method of claim 51 wherein the rod has a snap fitting at its distal end, and the free end has a snap fixed thereto, the step of retrieving comprising advancing the rod in a distal direction toward the free end to engage the snap in the snap fitting. 
     
     
       57. The method of claim 56 wherein the rod extends through the knotted loop, the step of threading comprising engaging the snap on the free end with the snap fitting on the rod and sliding the rod in a proximal direction to pull the free end through the knotted loop. 
     
     
       58. The method of claim 51 wherein the rod has a hook at its distal end, and the free end has an anchor fixed thereto, the step of retrieving comprising advancing the rod in a distal direction toward the free end to engage the anchor in the hook. 
     
     
       59. The method of claim 58 wherein the rod extends through the knotted loop, the step of threading comprising snaring the anchor with the hook and sliding the rod in a proximal direction to pull the free end through the knotted loop. 
     
     
       60. The method of claim 51 wherein the free end is disposed at a distal end of a movable jaw pivotally coupled to the shaft to form a side of the slot, the knotted loop being disposed on the shaft opposite the free end, the step of threading comprising closing the jaw to pass the free end through the knotted loop. 
     
     
       61. Ligating apparatus comprising: a shaft having a proximal end and a distal end;   a length of suture having a proximal end, a distal end, and a knotted loop in the suture spaced proximally from the distal end;   means near the distal end of the shaft for detachably supporting the distal end of the suture and the knotted loop in a spaced-apart configuration to define a receiving space therebetween, whereby the receiving space can be placed over a tissue structure to be ligated;   means actuable from the proximal end of the shaft for capturing the distal end of the suture and drawing said distal end through the knotted loop to form a ligature around the tissue structure; and   means actuable from the proximal end of the shaft for drawing proximally on the proximal end of the suture to tighten the knotted loop onto the distal end of the suture which has been drawn therethrough.